Arkansas Blog

Trumpcare: 'What were they thinking'

That's columnist Paul Krugman's question on the House Trumpcare plan in light of the devastating report by the Congressional Budget Office that it would eventually cost 24 million people their insurance coverage.

Still, he says, don't be so sure it won't become law.

Now my questions: First, can this legislation still go through? I have learned never to underestimate the cravenness of Republican “moderates,” who may posture to the center but almost always cave to the hard right when it matters. But even so, it’s hard to imagine this act of cruelty getting 50 senators. And if it can’t pass the Senate, won’t right-wing purists in the House decide to advertise their purity by voting against a bill that still falls short of free-market ideals rather than vote for Obamacare 0.5?

Second, what were Republican leaders thinking? Something like this C.B.O. score was a foregone conclusion; would it really have mattered much if it were 15 million losing insurance, not 24 million? How was this supposed to work out politically?

Perhaps for a clue we can look to U.S. Rep. Bruce Westerman. He Tweeted:

States should at least have an option for block grant funding with full flexibility to innovate & implement in new healthcare law.

Much to be said here and I think it goes to the heart of the difficulties the Republicans created for themselves. You can't do much about outcomes for people without insurance. You don't have much money to spend if you give a whopping tax cut to rich people and end mandated coverage. Smaller outlays to the states (and the block grants WILL be less than Arkansas is now receiving) — after the private insurance companies manage the money and take their profit out — seem certain to have an unavoidable "outcome." Many millions fewer people with insurance coverage. If by focusing on outcomes, you mean reading the obituary page, well OK then.